Introducing the Keynote Speaker for The 39th Annual Samuel Levey Healthcare Leadership Symposium

By: Mackenzie Schutz (MHA ’19)

The University of Iowa Department of Health Management and Policy is excited to host the 39^thAnnual Samuel Levey Healthcare Leadership Symposium on Friday, April 20^th, 2018. This year’s theme, Vital Changes: Leading Healthcare Organizations to Peak Efficiency, includes an extraordinary group of speakers and panelists, including keynote speaker Dr. John Toussaint, CEO and Founder of Catalysis. Dr. Toussaint is one of the foremost figures in the field of applying lean principles to healthcare and is ready to share his knowledge with our students, faculty, and alumni. 

Dr. John Toussaint (MD '82) Founder and CEO, Catalysis

Mackenzie Schutz: What sparked your interest in healthcare, and how did your background lead you to the work you do today? 

Dr. John Toussaint considers his route to where he is today to be rather "circuitous". Having an early interest in science and processes, he pursued chemistry at Cornell College with the goal of becoming a chemical engineer.  Opportunities to conduct research in the psychology department at the University of Iowa led him down an alternative route to medical school, a residency in internal medicine, and private practice for nearly 15 years. 

Alongside the practice of medicine, Dr. Toussaint recalls also doing a lot of administrative work, particularly once he became the president of an insurance company, a health maintenance organization (HMO). He states at that point in his career, "it became clear that I was interested in the business components of medicine."  

Through years of leadership opportunities within the HMO, Dr. Toussaint recalls, "I was very disappointed in the way we were performing in terms of the ability to improve things but never being able to sustain any of the improvement. So, when I became CEO I really studied industry." He discovered numerous companies using a method called Lean, or the Toyota Production System. At the time of his discovery, the healthcare industry was not giving these methods much thought; however, Dr. Toussaint chose to devote time and effort into learning and applying these methods, leading to improved care delivery and cost savings. 

In 2008, he stepped down from the CEO position to form Catalysis, a not-for-profit education institute. Dr. Toussaint describes the purpose and drive for the organization in this way: 

"We work with CEOs and senior executive teams around the world to apply the principles of the Toyota Production System to healthcare. We have a number of examples throughout the world now of terrific quality and cost results related to the use of this method. It is not taught anywhere in school, which is terribly unfortunate, so when you get out you have to relearn everything. Which is why I do what I do.  People are coming out of their training programs with zero knowledge of probably the most important thing in terms of operations performance that could make a difference."    

MS: Where did you develop and practice most of your knowledge around lean principles?

Dr. Toussaint: "I had a coach and a mentor and I did a lot of observation. A lot of this work is learning by doing. I did a lot of work to try to understand this method and I kept going back to manufacturing because there were no good examples in healthcare. That is not true today, there are some excellent examples now in healthcare." 

MS: When you speak to physicians about adopting lean principles, what are their primary concerns? How can administrators engage these physicians?

Dr. Toussaint: "I do a number of things. I coach the top physician executive in a number of organizations. We do a peer- to- peer learning activity with chief physician officers throughout North America. We get them together twice a year to learn from each other, and I am the facilitator of the learning process. I do a number of medical staff retreats. I have done retreats recently at UCLA and at Kaiser Permanente. We have a few physician faculty on our staff that will go do specific customized projects related to trying to engage physicians in the thinking around improvement processes."  

MS: Are physician engagement levels different based on whether a physician is practicing in a predominantly fee-for-service (FFS) or capitated environment?  

Dr. Toussaint: “If you are in a fully FFS environment, then you are going to work on throughput because the more patients you see, or surgeries you do, or labs you run, the more you get paid. In contrast, in a capitated environment, incentives revolve more around removing waste from the system to increase quality of care and reduce costs."

MS: What are some common misconceptions about implementing lean methods that hold hospitals or leadership teams back from efforts to apply them?

Dr. Toussaint: "I think the biggest misconception is that the senior executives can hand it off to somebody else and they don’t have to be involved. Where we see the biggest failure is lack of executive engagement: they think it’s just another project. Most healthcare executives are just doing projects and not trying to transform culture. This is a cultural transformation method, it’s not project based." To further explain this point he adds, " Principles are not enough. It is really about behaviors. The principles are the bedrock of the method, but it is the behavioral change at the level of the leadership and the management that is required to be successful." 

MS: What resources, examples, or tools do you recommend for individuals who wish to expand their knowledge of lean principles? 

Dr. Toussaint: "The simplest thing to do is to visit one of the Catalysis Healthcare Value Network members. There are 75 of them. If you go to: createvalue.org and look under ‘Networks’ you can see who is actually applying these principles, because most places are not. The best way to learn is just to go see. Most of these leaders and these organizations are very willing to share, and I would guess if you just call them up and request to spend the day understanding how their management system is different than what you have been taught, most of them would say yes." 

MS: What would be your primary message to aspiring leaders in the field? 

Dr. Toussaint: "First, go to the gemba and understand the barriers that the people who are taking care of the patients are facing. If you do that, you will see how broken the system is. The gemba is the place that the value is created for the customer.

Students should observe a nurse for 30 minutes and write down every single problem that you see that nurse face. It will knock your socks off how screwed up the system is: how many workarounds the nurses have to do, all of the hunting and gathering they do to find equipment. It will be an eye-opening experience.

Second, do not go write up the project that is going to fix the problem. That is the other mistake that healthcare managers and leaders make, saying ‘I have the answer to the problem and so I am going to solve it for you.’ That is Six Sigma mentality. The nurses know the problems, and the nurses need to fix the problems, and the job of the manger is to help facilitate the process by which those frontline workers can actually change the system so that it works. That is the thing that we are just not doing hardly any of in healthcare. We go away thinking, ‘Oh I’ve got the answer to that problem,’ and the reality is, you don’t have a clue!" 

The University of Iowa Department of Health Management and Policy looks forward to welcoming Dr. Toussaint to campus on April 20th! For more information about the 39^thAnnual Samuel Levey Healthcare Leadership Symposium or to register online, click here.